Stress And Mental Health

Life events

1967 Holmes & Rahe presented a psychosocial view of illness - complex relationship between life changes and development of illnesses Illness happens after major life events Not all events have the same effects Recent Life Changes Questionnaire (p. 270, Boyd text)

Coping

A deliberate planned & psychological effort to manage stressful demands Positive coping leads to adaptation, a balance between health & illness

Adaptation

A person's capacity to survive & flourish (Lazarus 1999) Affects health, psychological well-being, and social functioning

Sociocultural Factors

Cultural expectations and role strain - stay in abusive relationship to avoid the stress of violating a cultural norm of lifelong marriage Employment - highly valued cultural norm; personal identity; offers status Gender expectations

Demands and contraints

Internal demands - physiological & psychological needs External demands - imposed by the physical environment: crime, crowding, pollution Constraints - limitations both personal & environmental : cultural values & beliefs; finite resources (money & time)

Overall goals of interventions

Resolve the stressful person environment situation Reduce stress response Develop positive coping skills

Psychical and Social environment

Social networks - social and emotional support; enhance ability to cope with change; the larger the network, the more support Social support enhances health outcomes and reduces mortality by helping members make needed behavior changes and helps buffer stressful life events A person can have a large complex social network but little social support

Appraisal

Stress responses are affected by the personal meaning of a situation A given event or situation may be extremely stressful to one person but not to another

Three Stages

1. Alarm - body responds physiologically 2. Resistance - coping mechanisms used to try to reestablish homeostasis 3. Exhaustion - if homeostasis not achieved

Care for the Person Experiencing stress

Biological, Psychological, and Social domains

Values and Goals

Influence the significance of a particular event. The more important the goal or the more difficult the goal is to obtain the greater the likelihood of stress.

Two important factors that determine whether an individual experienced a stress response

Person-Environment Relationship Appraisal

Person-Environment Relationship

The interaction between and individual and the environment that change throughout the stress experience

Stress

The process by which we perceive and respond to certain events, called stressors, that we appraise as threatening or challenging. Associated with the development or exacerbation of symptoms of mental illness.

Allostatic Load

The total, combined burden of stress and disease that an individual must cope with.

4 personality types

Type A- competitive, aggressive, impatient, ambitious Type B- More relaxed, easy going Type C- Introvert, avoid conflict Type D- Increased negative emotion, pessimistic

Acute stress

can lead to physiologic overload and can have a negative impact on a person's health

Chronic Stress

clearly associated with negative health outcomes

General Adaptation Syndrome

corticosteroid secretion from the pituitary gland increased during stress contributes to the development of illness

Emotional Responses to Stress

depend on the significance of the event; often provoke impulsive behavior (run home)

Reappraisal

happens after coping; provides feedback about the outcomes

Diathesis Stress Model

suggests that a person may be predisposed for a mental disorder that remains unexpressed until triggered by stress

Allostasis

the body's ability to maintain a stable physiological environment by adjusting and changing to meet internal and external demands

Concept of Homeostasis

the body's tendency to resist physiological change & hold bodily functions relatively consistent & stable "flight or flight" response

Physiologic Response to Stress

the riskier the situation, the more intense the physiologic response

Chronic Stress

unrelieved stress that continues to tax a person's resources to the point of exhaustion; stress that is damaging to health.

Two types of coping

◦ 1. problem-focused - attacks the source of stress & solves the problem ◦ 2. emotion-focused - reinterpreting the situation to change its meaning

Psychological Domain

◦ Appraise the personal meaning of the situation ◦ Assess during nurse-patient interview ◦ Determine if person uses problemfocused or emotion-focused coping strategies

Social Domain

◦ Assessment should include use of the Recent Life Changes Questionnaire ◦ Identify person's social network ◦ Assessment of any recent changes in employment ◦ Changes in school attendance

Interventions

◦ Encourage patients to examine times when coping has been successful ◦ Discuss alternative coping strategies

Interventions

◦ Facilitate family unit functioning ◦ Parent education ◦ Family therapy referral if needed

Biologic Domain

◦ Health history ◦ Review of systems ◦ Gender differences ◦ Physical functioning ◦ Pharmacologic assessment

Sympathetic nervous system activates the HPA axis

◦ Hypothalamus secretes CRH ◦ Pituitary gland increase secretion of corticotropin ◦ Adrenocortical secretion of cortisol

Interventions

◦ Reinstating grooming ◦ Nutritional education ◦ Relaxation techniques ◦ Explore the value of exercise